Laalou F-Z, Jochum D, Pain L
Service D'anesthésie, Groupe Hospitalier du Centre Alsace, Hôpital Albert-Schweitzer, 201, avenue d'Alsace, BP 20129, 68003 Colmar Cedex, France.
Ann Fr Anesth Reanim. 2011 Oct;30(10):e49-53. doi: 10.1016/j.annfar.2011.08.009. Epub 2011 Sep 25.
The femoral neck fracture is a major cause of morbidity and mortality in the elderly. The etiology of cognitive impairment observed in this population of aged patient seems to be multifactorial. In the strategy of prevention, elderly patient must have the clearer information dealing with the postoperative cognitive dysfunction. This would reduce the incidence of POCD and some cognitive complaints, which often reflect the anxiety of the elderly patient facing the possibility of cognitive impairment. During the anaesthesia consultation, it seems important to assess the cognitive function of this elderly patient (like using neuropsycholgical scale as the MMSE) and to identify associated risk factors of cognitive dysfunction. The management of cognitive disorders should be multidisciplinary, the anesthesiologist being the main referent, in collaboration with the geriatrician and the surgeon. In the clinical setting of femoral neck fracture in the elderly, this multimodal management (pain, nutrition, functional rehabilitation to make these patients autonomous as quickly as possible), seems to improve the functional prognosis and to have the observed POCD decreased.
股骨颈骨折是老年人发病和死亡的主要原因。在这群老年患者中观察到的认知障碍病因似乎是多因素的。在预防策略中，老年患者必须获得关于术后认知功能障碍的更清晰信息。这将降低术后认知功能障碍（POCD）的发生率以及一些认知主诉，这些主诉往往反映了老年患者面对认知障碍可能性时的焦虑。在麻醉会诊期间，评估该老年患者的认知功能（如使用简易精神状态检查表[MMSE]等神经心理学量表）并识别认知功能障碍的相关危险因素似乎很重要。认知障碍的管理应该是多学科的，麻醉医生作为主要负责人，与老年病医生和外科医生合作。在老年股骨颈骨折的临床环境中，这种多模式管理（疼痛、营养、功能康复，以使这些患者尽快实现自理）似乎可以改善功能预后并降低观察到的术后认知功能障碍的发生率。
